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Action to reduce diabetic amputation rates

Recently released national data from Public Health England shows that there were 186 diabetes related amputations in East Lancashire and 71 diabetes related amputations in Blackburn with Darwen from 2013 to 2016.

Diabetes UK have launched a campaign called “Putting Feet First” https://www.diabetes.org.uk/get_involved/campaigning/putting-feet-first. You can watch a useful video here: https://youtu.be/Vk4xPfgnXWU

NHS East Lancashire CCG, Blackburn with Darwen CCG and East Lancashire Hospitals NHS Trust have been working hard over the last year to redesign and improve diabetes services in Pennine Lancashire. The new service arrangements for people with diabetes are currently being implemented following a period of consultation in the Autumn of 2016. The aim of this transformation is to ensure that services are provided closer to people’s homes, people with diabetes are monitored and supported according to their needs, and patients are trained to manage their diabetes through self care. This patient-centred shift in services will enable hospital specialists to focus on and treat those with more severe and complex cases of diabetes.

It is anticipated that as a result of this service transformation, diabetic patients will experience significant improvements in the diabetes services, and as a result, improvements in their outcomes.

Dr Rahul Thakur, a local GP with Special Interest in Diabetes said:

“Increased prevalence of type 2 diabetes and high rates of smoking are major contributing risk factors. People with diabetes who have foot ulcers should inspect their feet everyday and as stated in the Diabetes UK website , see GP or podiatrist immediately if there is any change. The absence of a foot pulse or a change in colour to blue is an emergency. People who are risk of developing type 2 diabetes should join the National Diabetes Prevention Programme. Known as the Healthier You programme, it is designed to empower people with a high risk of developing type 2 diabetes to take charge of their health and wellbeing. After completing an initial assessment, participants will meet in groups with a trained health and wellbeing coach for 10 weeks, followed by four monthly group maintenance sessions. Participants will also receive one to one progress review sessions with a coach. Throughout the programme, people will learn how to incorporate healthier eating, physical activity, problem solving and coping skills into their daily lives. Patients can be referred to this programme by their GP”.

Recently, the two CCGs and the Hospital Trust were successful in a bid to NHS England to support diabetes foot care. This has attracted additional funding of £211,646 across Pennine Lancashire [£148,152 for East Lancashire CCG and £63,494 for BwD CCG]. This will provide local GPs with a structured training programme called ‘Hands on Feet’, while in hospital services will received training in identification and screening. The programme will also offer patients a patient education programme to help them spot any problems before they worsen and require hospital treatment. Additionally the diabetic foot service will offer patients the ability to refer themselves, and they will be able to access the service through a “Hot Foot Line” and walk-in service. The service will also offer extended hours during the week and the weekend. The team provides a local foot care service in Burnley, Pendle, Ribble Valley and Hyndburn as well as Blackburn.

Structured patient education programmes are an essential part of the newly designed service. In Blackburn patients can join the DESMOND course, while in East Lancashire patients can access EMPOWER. These courses enable patients to get a stronger understanding of diabetes, and how best to look after themselves.

 A spokesperson for Lancashire Care NHS Foundation Trust’s DESMOND service said:

“With an estimated 4.5 million people living with diabetes in the UK and around 1.1 million people who have the condition but do not know, it is important people undergo regular check-ups to identify diabetes at an early stage and then take steps to successfully manage it. There are also some 11.9 million people in the UK who are at increased risk of getting type 2 diabetes and for them the best way to reduce the risk of diabetes is by eating better, moving more and reducing weight if overweight.

“People who have the condition in Lancashire can also access our DESMOND service to properly manage their condition. The idea is to empower people to self-manage their diabetes, improve glycaemic control, and reduce blood pressure, weight and waist circumference, and avoid future health complications. The DESMOND service is free and can be contacted on either 01772 777620 or 01253 283886 or by speaking to your GP, practice nurse or health care professional.”

The EMPOWER diabetes course is free and available to patients in east lancashire.. The course has been running since 2016 and the current evidence is that there has been an increased uptake in structured diabetic education from 1.5% to 54%. The increasing number of people learning how to look after their diabetes is anticipated to have an impact on improved outcomes in the longer term. NHS East Lancashire continues to promote this course and implement strategies to further improve uptake across all population groups.